Provider Demographics
NPI:1730189739
Name:ST GEORGE, JAMES K (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:ST GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8767 PERIMETER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5479
Mailing Address - Country:US
Mailing Address - Phone:904-402-8346
Mailing Address - Fax:904-402-8347
Practice Address - Street 1:8767 PERIMETER PARK BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5479
Practice Address - Country:US
Practice Address - Phone:904-402-8346
Practice Address - Fax:904-402-8347
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88184202K00000X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253128300Medicaid
F61242Medicare UPIN
FL253128300Medicaid